1457419129 NPI number — DR. JOHN FREDERICK JIMENEZ DDS

Table of content: DR. JOHN FREDERICK JIMENEZ DDS (NPI 1457419129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457419129 NPI number — DR. JOHN FREDERICK JIMENEZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ
Provider First Name:
JOHN
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457419129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3360 LACROSSE LN
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60564-8136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-369-4477
Provider Business Mailing Address Fax Number:
630-369-4422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3360 LACROSSE LN
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-8136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-369-4477
Provider Business Practice Location Address Fax Number:
630-369-4422
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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